AIDS: HOSPITAL TESTING SUGGESTED

The federal Centers for Disease Control on Thursday advocated the expansion of voluntary AIDS testing for people admitted to the hospital.

The move, it said, would bring millions of Americans into the screening process for the deadly disease.

A Cape Girardeau surgeon, Dr. Melvin C. Kasten, praised the idea. "I think it would definitely be a good idea," he said. "We eliminate a lot of diseases by routine testing in the hospitals."

For example, he said hospitals used to routinely test patients for syphilis.

Kasten said the American Medical Association has come out in support of voluntary testing of patients for AIDS.

"We think people should be tested, but it should be voluntary," said Kasten. "A lot of people don't know that they have got it."

Kasten said some patients might not want to be tested for fear that insurance companies would drop them if they test positive for HIV, the AIDS virus.

But he said such testing should be done for medical reasons. "It's a medical disease, not a legal disease," he said.

Kasten said part of the problem with AIDS testing is that state legislatures "have been holding us up" because they are worried that patient confidentiality will be violated.

But Kasten said surgeons many times must perform surgery on patients without knowing if those patients have the AIDS virus.

"If we don't know somebody has it, we are taking a chance," said Kasten.

"If we can't test for it, we can't control it."

This is the second time the CDC in Atlanta has proposed that hospital patients be tested for the AIDS infection.

In 1987, the CDC proposal met with opposition from the medical community and from AIDS advocacy groups.

In proposing hospital testing for the second time, the CDC said studies in urban hospitals since 1987 have shown AIDS infection rates ranging from 0.3 to 6 percent.

In two studies, the CDC said 63 to 65 percent of patients testing positive were unaware of their infection before being admitted to a hospital.

Jan Eichhorn, risk manager at St. Francis Medical Center, said Missouri law requires that a patient receive consultation about the disease before undergoing an AIDS test.

"We cannot do any HIV testing without first talking with the patients and counseling them," said Eichhorn. She said that task falls on the shoulders of both the doctor and the hospital.

But Kasten said he doesn't see such counseling as a barrier to voluntary testing. "Most of the young doctors are wanting to test because they are the ones who would lose the most if they happen to catch the disease from some patient."

Eichhorn said Thursday that she had not seen the details of the CDC proposal. She said the news accounts of the proposal raise "an awful lot of unanswered questions" dealing with implementation and other issues, such as insurance.

"Any illness is a concern to us in terms of the outcome of our patients," said Eichhorn. "I don't know that we are any more concerned about this" than other illnesses.

Chuck Keppler, risk manager at Southeast Missouri Hospital, said AIDS is "really a societal issue as much as a hospital issue."

Keppler pointed out that the CDC is talking about voluntary testing. "That's not anything the hospital can control."

Said Keppler, "Recommendations have no basis in law. Unless there are specific regulations that are based in law, then I don't know what you've got."

He said, "When there are laws and regulations, then we will com~ply with them."

The CDC proposal would not be binding on hospitals or doctors and also calls for patient consent for testing.

Although hospital employees and other health care workers run a risk of AIDS from tainted blood, the recommendation is aimed mostly at patients themselves, said CDC spokesman Don Berreth.

Currently, all military recruits and blood donors are tested and the CDC recommends testing of health care workers involved in exposure-prone procedures, and persons at high risk of contracting the disease, such as homosexuals and intravenous drug users.

As of July 31, a total of 186,895 cases of AIDS had been reported to the CDC since June 1980. There were 118,411 deaths from the virus.